Provider First Line Business Practice Location Address:
5152 KATELLA AVE
Provider Second Line Business Practice Location Address:
STE 202 OFFICE C
Provider Business Practice Location Address City Name:
LOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-269-5912
Provider Business Practice Location Address Fax Number:
562-269-5913
Provider Enumeration Date:
09/03/2021